March 9, 2024 - Is Acupuncture Safe?

Is Acupuncture Safe?

If you have never had acupuncture, you may have questions about it before feeling comfortable to try it. I can go on about the benefits of acupuncture and East Asian medicine; how it is a natural form of healing that uses your own energy or Qi; how it does not have any adverse side effects like Western medication can have; how it is a lifelong practice that involves nutritional and lifestyle advice as well…  But, if you have never had a treatment, there may be some fear. Fear about needles, fear about the unexpected. So here is some information that may help.

Is acupuncture safe? Are there points that are risky?

Acupuncture, on the whole, is safe. Are there things that could happen? Yes. This is why we are trained professionals. We learn about all of the risks; we are trained & tested extensively in how to avoid them.

What does it take to practice acupuncture legally?

·    To practice in most states, WA included, practitioners have to pass the National Board exams to become nationally certified.

·    We also do Continuing Education every few years to maintain our National Certification.

·    In addition, your acupuncturist needs to be licensed with your state Department of Health - this also depends on the state. In Washington state, DOH license is required.

·    You can read more about what is required by the WA state DOH, go to this link here: https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/acupuncture-and-eastern-medicine-practitioner/licensing-information

What about needling? Tell me more!

Let's talk about needling. Acupuncture needles, for the most part, are inserted very shallowly; the depth will depend on the place on the body. For instance, wrists and ankles, needles are inserted barely at all (about 1mm); whereas if we are needling into a large muscle, like the hamstring, we may insert the needle a little more (3-5mm).  This will also depend on the acupuncturist. And it is reasonable to ask your acupuncturist about their needle technique.

The other needling technique that is important is the angle of the needle. Depending on the point and place on the body, we will needle either perpendicularly or at an angle, or transverse/oblique insertion. Transverse or oblique insertion is used when we are needling near organs or veins or nerves. The transverse technique can also be used when we are directing qi away from an injury or to move the qi more assertively.

Another technique is needle manipulation. Whether the needle is manipulated or not. This is also very much dependent on the style of treatment and the preference of the acupuncturist, or how we were taught. After a needle has been inserted, your acupuncturist may or may not then slightly twist the needle in a clock-wise or counter clock-wise direction. I was taught to do this if, one, the qi is needing to be dispersed more assertively because of an excessive condition; or two, if I'm working on a tight muscle or scar tissue. 

Is it possible to have an adverse reaction with acupuncture? Yes

"…to avoid these adverse reactions, the needle quality should be strictly controlled, acupuncturists or other professional operators should receive strict and standardized training…"

I recently read a study of 535 systemic reviews globally, that included 53 studies that reported acupuncture adverse events. The adverse events ranged from slight pain upon insertion (usually associated with the needle being inserted into a blood vessel) - to infection to headache or dizziness. The global study found the incidence of adverse events ranging from 6.71% to 8.6% and the incidence of serious adverse events was about 0.001%. I've listed the key findings and clinical value below. If you'd like to read the full study, here is the link:  https://rdcu.be/dz9Zs

Additionally, there are points or places on the body where we needle more carefully, so as to avoid lung puncture, or other organ puncture. Those points are well known by acupuncturists and needling is done carefully so as to avoid any possibility of these risks.

 If you ever feel hesitant or unsure, you absolutely can let your acupuncturist know. I know, for me, I will adjust my treatment to ensure you feel safe.

Research Study - Key Findings

Among the 535 included SRs, 53 studies reported that acupuncture adverse events were associated with the practitioners. This may be attributed to the fact that most doctors, especially grassroots doctors, use acupuncture points based on their medical knowledge and experience.

Adverse events in medical practice have always been the focus of public and medical attention. Herein, we found that severe needle-related adverse reactions were rare, with the incidence of adverse events ranging from 6.71% to 8.6%, and the incidence of serious adverse events was about 0.001% [27, 28]. A comparison of the incidence of adverse events between acupuncture and conventional prescription drugs in primary care showed that acupuncture was a safe treatment [29]. Some adverse reactions, such as syncope, can be reduced by adequately preparing and positioning the patient, preferably in the supine, lateral or prone position. In addition, the patient should not feel hungry or fatigued. Care should be taken to avoid damage to nerves and blood vessels when acupuncture is directed at the umbilical points of the legs, arms, and face. In addition, doctors should pay more attention to aseptic operations to prevent infection. They should also reduce the force of acupuncture on very shallow acupoints to avoid damage to peripheral nerves, capillaries, and muscle fibers. 

Acupuncture is the insertion of one or several needles into the skin at specific sites or acupuncture points for therapeutic purposes [32]. This study has shown that many types and large numbers of adverse reactions are associated with acupuncture. In addition, these conditions may be caused by the patient's constitution (such as allergies to metal products or other complications), poor needle quality, or improper operation by the acupuncturist. Therefore, to avoid these adverse reactions, the needle quality should be strictly controlled, acupuncturists or other professional operators should receive strict and standardized training, and a pre-test (similar to a skin test before an antibiotic injection) should be performed to understand the patient's constitution before the acupuncture process.

Xu, M., Yang, C., Nian, T. et al. Adverse effects associated with acupuncture therapies: An evidence mapping from 535 systematic reviews. Chin Med 18, 38 (2023).